RESUMEN
BACKGROUND: Kounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappropriate treatment. The current literature is limited to case studies and there are no international recommendations concerning this topic. CASE PRESENTATION: We discussed, through two case reports, the clinical presentation and the management of a 60-year-old North African man and a 45-year-old North African man presenting with chest pain suggesting acute coronary syndrome following anaphylactic reaction. Triggering factors were a drug in the first case and herbal dermal exposure in the second. A clinical examination and electrocardiogram revealed anaphylactic reaction associated with myocardial infarction. Appropriate management of these two life-threatening conditions allowed an improvement in our patients' condition and their transfer to specialized units. CONCLUSIONS: Although Kounis syndrome is a rare phenomenon, physicians should be aware of its physiopathological mechanisms in order to treat it appropriately. The difficulty lies in the fact that the treatment of either of the two associated entities may worsen the other injury.
Asunto(s)
Amoxicilina/efectos adversos , Anafilaxia/inducido químicamente , Antiinflamatorios/efectos adversos , Anticoagulantes/efectos adversos , Dolor en el Pecho/inducido químicamente , Dexametasona/efectos adversos , Síndrome de Kounis/diagnóstico , Amoxicilina/administración & dosificación , Anafilaxia/fisiopatología , Antiinflamatorios/administración & dosificación , Anticoagulantes/administración & dosificación , Aspirina/uso terapéutico , Dolor en el Pecho/fisiopatología , Clopidogrel , Dexametasona/administración & dosificación , Electrocardiografía , Guías como Asunto , Humanos , Síndrome de Kounis/tratamiento farmacológico , Síndrome de Kounis/fisiopatología , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: During primary survey of trauma patients, missed injuries and delayed diagnosis can be a potential source of morbidity and mortality. OBJECTIVE: To assess type and frequency of missed injuries in prehospital care in trauma patients and to analyze their contributing factors and implications. METHODS: It is a descriptive and analytic prospective study. It was performed over six months which had included 200 trauma patients. The initial assessment made by the out-of hospital team of Sousse was compared to the second survey made in the emergency room and intensive care unit after the radiological assessment. RESULTS: Sixty seven (67) missed injuries were discovered in 51 patients, so 25.5% missed injuries incidence. These injuries were avoidable in 35.82% of cases. Twenty (20) injuries (29.85%) had clinically significant outcomes. Injuries are missed in the abdomen in 62.5% of cases, in the pelvis in 61.11% of cases, in the chest in 41.66% of cases, in the spine in 38.06 % of cases and in 20% of cases in the limbs. Multiple contributing factors were assigned, the most important were: the hemodynamic instability (Systolic blood pressure less than 90 mmHg), the tachycardia and the low RTS. Altered level of consciousness (GCS of twelve or lower), multiple and violence of the trauma were observed but not retained as predictive factors of missing injuries. CONCLUSION: Our study showed higher rates of severe missed injuries mainly in abdomen and pelvis. Circulatory instability and low RTS were assigned as significant factors predicting of this obviousness. Various solutions are proposed to prevent missed during the first assessment in prehospital care.